Tuesday, June 6, 2017

Health care claims that breach the million-dollar mark continue to rise, according to Sun Life's 5th annual catastrophic claims report. The report, which details the top 10 catastrophic medical conditions from 2013 to 2016, found that the number of multi-million-dollar claimants increased 68% from 114 to 192 during that period. While multi-million-dollar cases make up a small number of overall claimants, they are a greater proportion of reimbursement dollars. In 2016, multi-million-dollar cases made up 2.2% of claimants but generated 23% of total stop-loss reimbursements.

Over the four-year period, total costs for catastrophic claims reached $6.1 billion, with $2.7 billion paid in stop-loss reimbursements. Sun Life Financial U.S. is the leading independent provider of stop-loss insurance for self-funded employers who currently cover 4.6 million lives. Sun Life's catastrophic claims research also found:

Cancer dominates the top 10 - Based on dollar amount and percentage of total stop-loss claims, malignant neoplasms and leukemia/lymphoma/multiple myeloma (cancers) took spots 1 and 2 on the top-ten catastrophic claims list, representing more than a quarter (26.7%) of total stop-loss reimbursements from 2013-2016;

Breast cancer prevalence - Breast cancer is the most common form of cancer in the U.S., with an estimated 247,000 new cases reported in 2016, and an average paid claim amount of $147,100;

Transplants costs are high - Bone marrow/stem cell transplants are the costliest transplant procedures, with an average paid claim cost of about $400,000. Transplants were the most common high-dollar claim condition among 20 to 39 year-olds;

Highest individual claim - Of the top-10 conditions, the highest claim was $3.2 million, for malignant neoplasm (cancer). The attached chart details the highest claims in each top-10 condition;

The top three highest-cost conditions - Leukemia, lymphoma and/or multiple myeloma (cancers); congenital anomalies (conditions present at birth); and malignant neoplasm (cancers) are more likely to result in million-dollar claimants due to their frequency; and

IV medications tracked in the study pushed up costs - When looking at data on intravenous drugs, the report showed they accounted for 48% of total paid charges on the top five highest-dollar claimants. Of the 562 claimants exceeding $1 million between 2013 and 2016, 45 generated more than $1 million in high-cost intravenous medications. ...